From the 6/1/10 AUA Daily Scope:

Quoted from the International Journal of Radiation Oncology, 60-70% of men with low stage, low grade prostate cancers, with PSA less than 10 (frequently managed with Active Surveillance), will be found at Radical Prostatectomy to instead have bilateral and higher grade disease. This implies a risk for local or distant recurrences due untreated active disease.

And, from Prostate Cancer and Prostate Diseases: Men with Gleason 3+3 cancer and PSA’s in 2-3.9 range have 32.6% chance of having Gleason 7 or higher at Radical Prostatectomy when the whole gland can be examined. If the PSA is 4-10 in these men, 44% have higher grade cancer when the gland is examined after Radical Prostatectomy.

There’s more: From Northwestern University, investigators found that men with low risk prostate cancer who waited more than 6 months for surgery had double the risk of being found to have high grade cancer, and double the risk of biochemical (PSA) recurrence than those treated before 6 months after diagnosis. They conclude men with low grade cancer should be counseled on the increased risks of worse outcomes if they wait longer than 6 months for treatment.

May make us think twice on the safety of the Active Surveillance approach.

When HIFU was new, the treatments were administered to men with the machine mostly controlling the power settings after the urologist defined the boundaries of the prostate. Research by Dr. Mark Emberton in London has shown significantly improved results when the urologist adjusts the power settings according to the individual gland’s response to the heat. Different men will develop differing tissue temperatures with the same power administered. This affects the success of killing cancer and the development of scar tissue afterward.

Only the Sonablate unit allows us to constantly adjust the settings to tailor the treatment to the individual’s responses. See the posting regarding Tissue Change Monitoring for additional advantages of the Sonablate unit over other HIFU technologies.

Beginning March, 2009 the Tissue Change Monitoring (TCM) function was added to the Sonablate HIFU units in Puerto Vallarta. This feature uses a radio frequency signal before and after each firing to compare tissue changes from before and after the application of sound wave energy. It allows a clue as to whether an area may not have received sufficient energy (due to obstructing calcium deposits, cysts, etc.) to kill the cancer tissue, and enables us to go back and give the specific site another shot.

Actual post-treatment followup statistics will have to bear it out over the next few years, but I suspect the occasional need for re-treatment currently seen will be seen less often with this new feature. Very exciting!